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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. ` <br /> 0 O <br /> N O <br /> c <br /> m I <br /> OWNER TELEPHONE `a o �" <br /> m <br /> V Q <br /> MAILING ADDRESS F <br /> 0 <br /> 0 <br /> PROPERTY ADDRESS `) <br /> J <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ( /) <br /> TYPE OF PERMIT(S): a <br /> FILLINGIGR IN CAMPING UNIT SUBDIVISION <; <br /> N <br /> STRUCTURE/ADDITION USE: ` ' <br /> (. me/Ca in; om rcial Bu mess; Bedroom; Deck; etc) W <br /> BUILDING CONTRAC <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O .» <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n a <br /> , T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)To m (� ° <br /> CENTERLINE OF ROAD,(C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 41- Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. t <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO ` <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS (Z�. On Z>0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. / ` ° <br /> W <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <br /> Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Y <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER G) <br /> SETBACK AREA. <br /> 5 EXIST//dr /!pV$e W46 hppilQleo SL°��auuE' �Ywn, 01{w/1 aF blrlcN 1SGfiN� X m m > o n O m <br /> 6. N►Ke 8� zonit*� PaRMr r /112-3 !ov /9,43 C Se6h^c a .4v4M0 6 m �m C: ° y s � 3 <br /> Z �°C <br /> = rn : d,: <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my „ Ae <br /> 1 am responsible for the detail and accuracy of <br /> knowledge and belief it is true,correct and complete. I acknowledge that CL <br /> �N <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <br /> v o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am y/ <br /> providing in this ap ation. I a to permit county officials charged with administering county ordinances or other / o <br /> authorized persoK have ac s to t a described pre ises at py reasonable time for the purpose of inspection. -n m 'a <br /> / a <br /> SIGN HERE —D a <br /> (signatur o er or bui actor) (date) 0 <br /> ZONING ADMINISTRAT R 5l <br /> yi: . en F» <br /> ,A Efl EA fA N <br /> C,O UN10NN VNiO <br /> TO NSHIP PER ITS MAY BE REQUIRED v <br /> THIS PERMIT SHALL EXPIRE ONE YEARFROM DATE OF ISSUANCE L /r]_�� <br />